脊柱内镜与开放减压融合术对年轻肥胖腰椎间盘突出症病人的疗效对照研究

目的:评估脊柱内镜下减压手术与开放减压固定融合手术治疗年轻肥胖腰椎间盘突出症病人的中期临床疗效。方法:回顾分析2015年1月至2017年6月期间在我院疼痛科及骨科脊柱组确诊为腰椎间盘突出症并接受手术治疗的病人。以年龄18~45岁,BMI≥28 kg/m^2,因腰椎间盘突出症而接受手术治疗为入组标准。根据病人接受术式不同分为内镜组(62例)及开放组(25例)。以术前及术后24个月视觉模拟评分法(visual analogue scale,VAS)评分、手术时间、术中出血量、重返工作时间、MacNab评分、术后再手术率作为评价指标,分析两组差异,比较两术式的临床疗效。结果:内镜组62例病人平均年龄(31.2±8.2)岁,平均BMI值为(30.8±3.1)kg/m^2,平均重返工作时间(3.2±6.2)月,平均手术时间(68.5±36.6)分钟,平均出血量(5.1±4.2)ml。MacNab评分结果为优(50例)、良(5例)、可(1例)、差(6例),优良率88.7%。10例术复发再次接受手术(再手术率16.1%);开放组手术25例病人平均年龄(29.8±7.1)岁,平均BMI值为(31.6±3.7)kg/m^2,平均重返工作时间(5.7±4.2)月,平均手术时间(145.8±51.5)分钟,平均出血量(334.0±215.4)ml。MacNab评分结果为优(20例)、良(4例)、可(0例)、差(1例),优良率96.0%。1例术后症状复发接受翻修开放手术(再手术率4%)。两组病人年龄、BMI值和MacNab评分无统计学差异(P>0.05),重返工作时间、术后复发时间、出血量、手术时间有统计学差异(P<0.05),两组术后VAS评分均较术前明显下降。结论:对于年轻肥胖腰椎间盘突出症病人,脊柱内镜手术与开放减压固定融合术治疗均有明显疗效。而脊椎内镜术后出血量少、手术时间与恢复时间更短,病人能更快地重回工作恢复社会角色。此外,脊椎内镜术后二次手术率较开放减压固定融合术较高,推测脊柱内镜术后复发率较开放手术高。

Comparative study of the clinical effect between full-endoscopic operation and open decompression fusion in the treatment of young obese patients with lumbar disc herniation

Objective:To evaluate the mid-term clinical effect of endoscopic decompression surgery and open decompression and fixation fusion surgery in the treatment of young obese lumbar disc herniation.Methods:From January 2015 to June 2017,a total of 87 patients who were diagnosed as lumbar disc herniation in pain medical center and spine group of orthopedics department of our hospital were analyzed retrospectively.The patients of 18-45 years old,BMI≥28 kg/m^2,and surgical treatment for lumbar disc herniation were included according to the criteria.The patients were divided into endoscopic group(62 cases)and open group(25 cases)based on different surgical methods.The visual analogue scale(VAS)before and after the operation,operation time,Intraoperative blood loss,time to back to work,MacNab score and the rate of reoperation were used as the evaluation indexes.The differences between the two groups were analyzed and the clinical effects were compared.Results:The average age of 62 patients in endoscopic group was 31.2±8.2 years old,the average BMI was 30.8±3.1 kg/m^2,the average time to return to work was 3.2±6.2 months,the average operation time was 68.5±36.6 minutes,and the average blood loss was 5.1±4.2 ml.The results of MacNab were excellent(50 cases),good(5 cases),fair(1 case)and poor(6 cases).The excellent and good rate was 88.7%.10 patients received reoperation due to symptom recurrence(reoperation rate:16.1%).In the open group,the average age was 29.8±7.1 years old,the average BMI was 31.6±3.7 kg/m^2,the average time to return to work was 5.7±4.2 months,the average operation time was 145.8±51.5 minutes,the average blood loss was 334.0±215.4 ml.MacNab score was excellent(20 cases),good(4 cases),fair(0 case)and poor(1 case).The excellent and good rate was 96.0%.One patient with recurrent symptoms received open surgery(reoperation rate was 4%).There were no significant differences in age,BMI and MacNab score between the two groups(P>0.05),there were significant differences in back to work time,postoperative recurrence time,blood loss and operation time between the two groups(P<0.05).Conclusion:For young obese patients with lumbar disc herniation,endoscopic surgery and open decompression and fixation fusion surgery both have obvious curative effect.However,with less blood loss,shorter operation time and recovery time,patients can return to work faster and recover their social roles after endoscopic surgery.In addition,the reoperation rate after endoscopic surgery was higher than that of open decompression and fixation fusion surgery.It is speculated that the recurrence rate of endoscopic surgery is higher than that of open surgery.